良性前列腺增生合并膀胱过度活动症患者膀胱黏膜毒蕈碱型胆碱能受体 M2、M3亚型的表达及临床意义

摘要

Objective-To-investigate-the-changes-and-significance-of-the-expression-of-the-M-2-and-M3-receptors-of-the-urinary-bladder-mucosa-in-patients-with-benign-prostatic-hyperplasia-(-BPH)-and-overactive-bladder-(-OAB)-.-Methods-From-May-2012-to-February-2013,-20-cases-of-BPH-were-studied-on-the-International-Prostate-Syndrome-Scoring-(IPSS),-Quality-Of-Life-(QOL),-OAB-syndrome-scoring-(OABSS),-and-urodynamics.According-to-OABSS-results,-the-patients-were-divided-into-either-BPH-group-(n=9)-or-BPH-and-OAB-group-(n=11).Mucosa-biopsies-under-the-cystoscopy-were-performed-in-all-the-cases-.The-expression-of-M2&M3-receptors-was-assayed-by-reverse-transcription-polymerase-chain-reaction-(-RT-PCR-)-.The-mRNA-expression-levels-of-M-2-&-M3-receptors-were-indicated-by-the--Ct-values.-Results-The-levels-of--Ct-of-M2-&-M3-receptors-were-significantly-lower-in-the-BPH-group-than-those-in-the-BPH-+OAB-group,-respectively-[M2:(-0.154-±0.641)-vs.(0.562-±0.762),-t=-2.241,-P=0.038;M3:(2.534-±0.816)-vs.(3.639-±1.019),-t=-2.630,-P=0.017],-which-implied-that-the-expression-of-M-2-and-M3-receptors-was-higher-in-the-BPH-group-than-that-in-the-BPH-+OAB-group.The-median-ratios-of-M2∶M3-in-both-groups-were-respectively-6.5206-(2.35-17.33)-and-7.9447-(2.10-23.83)-(Z=-1.102,-P=0.271).In-the-same-group,-the-expression-of-M2-was-higher-than-M3-in-both-groups-(t=-7.776,-P=0.000;t=-8.018,-P=0.000).The-expression-of-M3-receptors-was-negatively-correlated-to-OABSS-(r=-0.466,-P=0.039)-and-QOL-(r=-0.496,-P=0.026).-Conclusions-The-expression-of-M2-and-M3-receptors-is-decreased-and-the-ratio-of-M-2∶M3-is-increased-in-patients-with-BPH-and-OAB-,-which-may-play-an-important-role-in-the-development-of-OAB.The-decreasing-of-expression-of-M-3-receptor-exacerbates-the-OAB-degree-and-reduces-the-quality-of-patients-’-life.%目的：探讨良性前列腺增生（ benign prostatic hyperplasia ，BPH）合并膀胱过度活动症（ overactive bladder ，OAB）患者膀胱黏膜毒蕈碱型胆碱能受体（ muscarinic cholinergic receptor ，M受体） M2、M3亚型表达水平的变化及临床意义。方法分析2012年5月～2013年3月20例BPH患者的国际前列腺症状评分（ international prostate syndrome scoring ，IPSS）、生活质量评分（quality of life，QOL）、膀胱过度活动症症状评分（OAB syndrome scoring，OABSS）和尿动力学检查。根据OABSS评分结果将其分为BPH组（9例）及BPH并OAB组（11例）。2组均在膀胱镜下钳取膀胱黏膜，经逆转录聚合酶链式反应（ reverse transcription-polymerase chain reaction ，RT-PCR）检测M受体M2、M3亚型mRNA的表达水平。 M2、M3受体mRNA表达水平采用相对于内参基因mRNA表达的相对值ΔCt值表示。比较2组M2、M3受体表达水平及相关性。结果 M2、M3受体表达的ΔCt值BPH组明显低于BPH并OAB组（M2的ΔCt值：-0．154±0．641 vs．0．562±0．762， t＝-2．241， P＝0．038；M3的ΔCt值：2．534±0．816 vs．3．639±1．019， t＝-2．630， P＝0．017），说明BPH组M2、M3表达水平均高于BPH并OAB组。2组M2∶M3分别为中位数6．5206（2．35～17．33）和7．9447（2．10～23．83）（Z＝-1．102，P＝0．271）。同组比较，2组M2表达水平均高于M3（t＝-7．776，P＝0．000；t＝-8．018， P＝0．000）。 M3表达水平与OABSS和QOL评分呈负相关（r＝-0．466，P＝0.039；r＝-0．496，P＝0．026）。结论 BPH合并OAB症状的患者，其膀胱黏膜M2、M3表达水平下降，且M2∶M3比例在合并OAB后有升高的趋势，在OAB发病中起一定作用。 M3表达的下降，加重了OAB的程度，降低了患者的生活质量。